By William C. Shelton

(The opinions and views expressed in the commentaries and letters to the Editor of The Somerville Times belong solely to the authors and do not reflect the views or opinions of The Somerville Times, its staff or publishers)

Republican leadership is flailing about for a healthcare bill that will not immediately make obvious the cruelty at the heart of their enterprise. Meanwhile Democratic leaders advocate doubling down on a failing program.

Single-payer healthcare is a system in which a state covers basic healthcare costs for all of its citizens. It would deliver better outcomes at far lower costs. And it would increase the probability of a more egalitarian and less authoritarian society when, by mid-century, half or more of the nation’s jobs have disappeared.

Lower costs

Americans pay more for healthcare than any other people on earth. We pay twice as much or more than most of the 35 developed capitalist democracies in the Organization for Economic Cooperation and Development.

Our per-person expenditures are 126% those of the Swiss, who have the next costliest healthcare system. They are 214% of the Japanese, who have the world’s highest life expectancy, and 210% of the French, who are widely considered to have the world’s most effective system.

And those cost differences are all the more stark when one considers how many Americans—unlike Swiss, Japanese, and French—remain uninsured.

A single-payer system would vastly reduce costs. Medicare administrative expenses, for example, average about 2 percent of total costs, less than one-sixth the corresponding percentage for many private insurers. And single-payer systems don’t have to spend money on competitive advertising, which can amount to more than 15 percent of total expenses for private insurers.

But by far, the greatest cost savings would come from economies of scale and the bargaining power of a single payer. Bargaining power is why virtually every common medical procedure costs so much more here than in other developed countries. (Cornea transplants, the one exception, are more expensive in Switzerland.)

It’s why the average cost of a routine office visit in the U.S. is $95, while it’s $30 in Canada and France. It’s why the average bypass surgery cost in the U.S. is $73,420, while it’s $26,432 in France and $14,117 in the U.K.

It’s why we pay twice as much for the same brand-name drugs that citizens in other countries buy. And to ensure that this continues, lawmakers block drug importation from those countries, while U.S. pharmaceutical and medical device companies’ profit margins are 20 percent, and they spend only 12 percent of revenues on innovation.

Better outcomes

Another important reason why universal-care systems are less expensive is that those served by them receive preventative care throughout their lives, and “an ounce of prevention is worth a pound of cure.” By covering everyone and emphasizing preventative care, many health problems never arise, while those that do can be identified at an early stage, when treatment is more effective and less expensive.

Despite our healthcare system’s being the most expensive, it produces shameful outcomes. Both the United Nations and the CIA rank U.S. life expectancy at 43rd in the world. The United Nations puts our infant mortality rate at 40th best in the world (for the period after 2010), while the CIA puts it at 57th. The World Health Organization ranks the U.S. healthcare system 37th in efficiency, between Costa Rica and Slovenia.

The system’s staffing levels are low, and it lacks safety controls, putting staff and patients at risk. More than 250,000 Americans die from medical errors each year, making those errors the third leading cause of death, after heart disease and cancer.

But single-payer systems can disseminate and encourage best practices. Mitchell Selzer, a leading hospital consultant, studied the practice profiles of 24,000 physicians treating 1.5 million patients. He found that a subgroup of those doctors consistently admitted, diagnosed, and treated patients using 20-to-30% fewer resources than average. Yet this group produced fewer errors, shorter stays, fewer infections, fewer readmissions, and fewer deaths.

A better future

Those who study such things tell us that somewhere between twenty and sixty years from now digital technology and robotics will eliminate half the jobs in the economy. The options for what our society will become range from one in which we live comfortably, sharing work and enjoying ample leisure, to one in which the great majority of us struggle for economic survival, kept in our place by a police state.

The trajectory of the last forty years’ aims us more toward the latter future than the former. Productivity gains have been entirely appropriated by the wealthiest of us; working people have lost extensive protections and bargaining power; and as Thomas Picketty observes, wage inequality in the United States “is probably higher than in any other society at any time in the past, anywhere in the world.”

Creating universal healthcare through a U.S. single-payer system would alter that trajectory. It would establish that we are all in this together, and that every human deserves a human existence.

A problematic present

In the 2009 run up to Obamacare, Democratic leadership refused to even allow testimony on a single-payer approach. Instead they dredged up a 1990s plan from the conservative Heritage Foundation and made it more expensive and much more complicated. Premiums continue to rise, while tens of millions remain uninsured.

These same leaders now want to “stabilize the market,” which means giving health insurance companies even more public subsidies so that they will not greatly raise premiums, while remaining sufficiently profitable. Adding a “public option”—allowing people to purchase public instead of private insurance—would just add complexity and bureaucracy while attracting the sickest and most expensive enrollees.

A slim majority of Americans now supports single-payer healthcare. Even this is surprising given the extent to which awareness of such a system’s capacity to improve the nation’s health while shrinking deficits has been suppressed or falsified.

So hostile lawmakers and their owners are shrieking that a single-payer system would raise taxes by $32 trillion over a decade. They ignore—and hope the electorate will ignore—that it would save taxpayers, families, and businesses far more than that. Similar propaganda has been sufficient to stall single-payer legislation in California, Colorado and Vermont.

It may not be politically feasible to pass a single-payer system in this moment. But the more its proponents educate and advocate, the more it becomes the obvious choice as Republican alternatives reveal their cruelty and Democratic alternatives become more costly and inefficient.



In my last column, “Every candidacy needs a reason,” I wrote that Alderman Bob McWatters is not accepting campaign donations from developers. This is literally true in that Bob is not accepting donations from developers in this campaign cycle. But it may be misleading.

He did accept such a donation in the past. It was $500 from Douglas Beaudet. Mr. Beaudet owns 515 Somerville Avenue. In 2015, some city officials were considering taking the property by eminent domain for a fire station. In response to opposition from Somerville residents and skepticism by aldermen, the plan was abandoned, leaving Mr. Beaudet free to develop his property.

I had researched Alderman McWatters’ campaign contributions before I wrote the column, but did not recognize Mr. Beaudet as a developer. I apologize for the inaccuracy.


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